The chair of a gross negligence manslaughter review commissioned by the GMC has rejected calls for a 'no-blame' culture in the NHS, warning it could give the 'wrong impression' when patients come to harm.

GMC review chair Dr Leslie Hamilton

In a progress update published by the GMC, Dr Leslie Hamilton - who replaced Dame Clare Marx as chair of the independent review in July last year - wrote: 'Calls to adopt a "no-blame culture" give the wrong impression.'

He added: 'No blame has limits - if a doctor deliberately harms or wilfully neglects a patient then of course they should be blamed, and held to account.’

Despite questioning the language around calls for a 'no blame' culture, Dr Hamilton backed a move to a more 'just culture' in which doctors who make ‘genuine errors, particularly when under pressure, are encouraged to admit to them’.

System failure

He added: ‘If a patient comes to harm in such circumstances then the focus should be on how and why it happened, why the system has failed to protect the patient, and not on the actions of an individual doctor.

'Other high risk industries – nuclear, aviation, oil – assume that staff will make errors and so build in safety measures. Yet in healthcare there seems an assumption that as long as everyone tries hard enough it will be completely safe.’

Pressure group The Doctor’s Association UK (DAUK), launched a campaign called 'learn not blame' in the wake of the high-profile case of Dr Hadiza Bawa-Garba, a junior doctor struck off the medical register after a GMC challenge but later reinstated.

The group has demanded an NHS culture that ‘acknowledges and learns in a constructive and fair manner when things go wrong’. In a submission to the GMC’s manslaughter review, DAUK wrote: ‘It is imperative that the judicial system recognises that mistakes and human error are often the result of multiple factors... It must be recognised that individuals working in a system which is failing should not be held responsible for the death of a patient, especially where the removal of systemic failures may have contributed to a better outcome.

Supportive culture

‘A supportive culture of learning and not apportioning blame or punishing individuals is required so that clinicians have faith in reporting their mistakes or system failings.'

In his update, Dr Hamilton said he and his team had received almost 800 written submissions; held 20 oral evidence sessions; had almost 40 one-to-one meetings, and hosted workshops across the UK attended by around 200 people.

‘It was hugely important to us to hear directly from as many different voices as possible, including from those who have been through the process and who know, first-hand, what it is like and how it could be improved,’ he wrote.

‘Some themes are emerging. The quality of local investigations; the importance of independent, impartial expert medical opinion; the involvement of, and support for, bereaved families; the prospect of "multiple jeopardy" faced by doctors, and the level of support available to them, have all been raised, as of course, have the GMC’s processes.’

Dr Hamilton said his team was now bringing all the evidence together and ‘beginning to formulate our recommendations’. The report is expected to be published in the spring.